Question 1

The nurse executive works hard to create a civil workplace that does not tolerate harassing behaviors. How would this nurse best explain the reason for this emphasis on civility?
A) "Bullying behaviors make nurses uncomfortable."
B) "Physicians do not want to admit clients to hospitals with an uncivil atmosphere."
C) "Bullying and incivility are just not proper work practices."
D) "Bullying and incivility are dangerous to client care."

Accepted Answer

Bullying and incivility can directly impact quality of care and patient outcomes. It is important to create a safe and respectful workplace to ensure patient safety and positive health outcomes.

Question 2

A nurse makes a medication error and notifies the client's physician. The physician berates the nurse over the phone and states, "You are an idiot." How should the manager deal with this situation?
A) Tell the nurse to go home for the rest of the day.
B) Have the nurse call the physician back and demand an apology.
C) Document the facts of the encounter.
D) Privately tell the physician that the behavior was bullying.
E) Confront the physician during rounds and demand an explanation.

Accepted Answer

C,D,E

Question 3

A hospital administrator has attended a conference on bullying and wishes to address the most likely bullies in the organization. Whom would the administrator invite to the first meeting about bullying behaviors?
A) Nursing assistants
B) Physicians
C) Managers
D) Office personnel
E) Senior nurses

Accepted Answer

B,C,E

Question 4

A hospital administrator is investigating why the turnover rate is so high and why it is difficult to attract new nursing employees. Which situation is most likely to have resulted in this problem?
A) The hospital is in a poorer part of town and offers a great deal of charity care.
B) The hospital pays about $.25 per hour less than other hospitals as a starting wage for nurses.
C) The hospital has a reputation for allowing bullying behavior to occur.
D) The other hospital in town has a more modern building and campus.

Accepted Answer

All of the choices could potentially contribute to the high turnover rate and difficulty in attracting new nursing employees, but allowing bullying behavior to occur in the workplace is a major issue that can significantly impact employee morale and job satisfaction. This can lead to employees leaving the organization and making it less attractive to new hires.

Question 5

The manager has determined that a nurse is marginal, but elects to ignore the situation for now, hoping the nurse's work will improve. What risks has the manager taken by choosing this strategy?
A) The nurse may harm a client.
B) Other nurses on the unit may become disgruntled by having to cover for this nurse.
C) The nurse may never become a good employee.
D) The manager may be terminated.
E) The morale of the unit may decline.

Accepted Answer

Ignoring a marginal nurse can lead to potential harm to clients, dissatisfaction among other staff, the nurse not improving, and a decline in unit morale.

Question 6

What characteristics would cause the manager to classify an employee as marginal?
A) The employee works only when client census calls for additional staff.
B) The employee's work does not improve with coaching.
C) The employee just made an error for which discipline has already been done twice.
D) The employee has worked at the facility for less than 1 month.
E) The employee does not mix well with the other staff, but stays on the margins of the group.

Accepted Answer

Marginal employees are those who do not meet the expected level of performance and do not show improvement even with coaching. Disciplinary actions are taken when an employee makes repeated errors, which is a characteristic of a marginal employee. The other options, such as working only when client census calls for additional staff, being a new employee, or not socializing well with others, may not necessarily indicate poor performance or marginal status.

Question 7

A nurse manager does not like conflict and would like to allow instances of bullying to "go away on their own." What rationale by the manager's supervisor is the most important?
A) "The Joint Commission requires that we address instances of bullying."
B) "We don't want to run off good nurses."
C) "If you let bullying go, it just gets worse and more frequent."
D) "A bully makes the work environment unpleasant for everyone."

Accepted Answer

All of the options are important to consider, but option C is the most important in this situation. Allowing instances of bullying to "go away on their own" can actually make the situation worse, as bullies often continue their behavior if it goes unchecked. It can also create a culture where bullying is acceptable, which can be detrimental to team morale and patient care. The Joint Commission requirement (option A) is important to take into account, but not as critical as addressing the issue before it escalates. While running off good nurses (option B) is not ideal, allowing bullying to continue can also lead to good nurses leaving. Option D is also important to consider, as a bully can create an unpleasant work environment that affects everyone's job satisfaction and ability to provide quality care.

Question 8

Two staff members have a long-standing dislike of one another. Generally they hide their feelings, but occasionally they engage in name-calling and derogatory remarks. Today their dislike erupted into a shoving match in the break room. How should the manager handle this situation?
A) Tell the two staff members to go to the manager's office immediately.
B) Send both of the employees off the unit.
C) Immediately call for security.
D) Stand between the employees and tell them to calm down.

Accepted Answer

1. The manager should not try to intervene when physical violence is occurring.
2. The manager should not send these employees off the unit. Violence may continue or escalate.
3. Security should be notified immediately when physical violence occurs or is imminent.
4. The manager should not risk harm to self by standing between these employees.

Question 9

A nurse manager is struggling with two marginal nurses and goes to the supervisor for advice. How should the supervisor advise the manager?
A) "Continue to be persistent in your work with these nurses."
B) "You can fire them at any time."
C) "Be fair and consistent with them."
D) "You must continuously assess the rest of your staff as you work with these two nurses."
E) "You must continue to address the issues with these nurses as they arise."

Accepted Answer

The answer of A nurse manager is struggling with two...

Question 10

A night shift nurse is assuming a day shift nurse's assignment, which includes two clients whose pain is being controlled with oral hydrocodone (Lortab). At shift assessment, both clients complain of pain. During shift report, the day shift nurse reports that both clients had just received two hydrocodone (Loratab) tablets for pain. What action should the night shift nurse take?
A) Repeat the medication.
B) Inform the manager of the situation.
C) Call the physician to obtain an order for IV narcotics.
D) Tell the clients that pain medication will be given at the next ordered time.

Accepted Answer

The answer of A night shift nurse is assuming a...

Question 11

The chief nurse officer (CNO) has received numerous complaints by staff regarding their manager. The staff describes behaviors such as not granting requested days off, favoring other staff members, and allowing lateral violence in the department. Which statement by the CNO to the manager would specifically describe a lack of civility?
A) "Your behavior is rude and disrespectful towards your staff."
B) "This behavior is unprofessional."
C) "This behavior is unacceptable."
D) "This behavior warrants a written warning."

Accepted Answer

The statement "Your behavior is rude and disrespectful towards your staff" specifically addresses a lack of civility, which involves treating others with respect and valuing their opinions and perspectives. The other choices imply unprofessionalism or a breach of policy, but do not specifically address the importance of respectful behavior in the workplace.

Question 12

A nurse says, "I don't see what all the fuss is about bullying. Every new nurse has to go through it. It's just a part of the history of nursing." How should the manager respond?
A) "I know. It's a shame that all the old ways are changing."
B) "Why would you want to bully a new nurse? They are all so naïve and cute."
C) "The Joint Commission does not tolerate disruptive or abusive behavior."
D) "The American Nurses Association does not approve of bullying behaviors."
E) "New nurses bring new ideas. Why would you bully them?"

Accepted Answer

The answer of A nurse says, "I don't see what...

Question 13

Which assignment would be in the best interest of a nurse reentering practice following treatment for abuse of mood-altering drugs?
A) Place the nurse on a different unit and allow the administration of all drugs.
B) Reassign the nurse for a period of time to a unit where no mood-altering drugs are given.
C) Retain the nurse on the original unit and allow the administration of mood-altering drugs.
D) Return the nurse to the original unit at a less stressful time, such as night shift.

Accepted Answer

Reassigning the nurse to a unit where no mood-altering drugs are given would be the best option to ensure the safety of the nurse and the patients. It would also provide an opportunity for the nurse to focus on their recovery without the added stress and temptation of working with those drugs. Once the nurse has demonstrated stability and fitness for gradually returning to the administering of drugs, then a reevaluation can be made.

Question 14

A night shift charge nurse frequently points out nurses' faults in front of coworkers. The manager of the unit has submitted a written warning to the charge nurse. What term should the manager use to label this behavior?
A) Lateral violence
B) Unprofessionalism
C) Lack of civility
D) Bullying

Accepted Answer

1. Lateral violence is harassment between employees of equal rank.
2. The behavior is unprofessional, but that is a very broad term and does not identify the issue in this particular case.
3. Lack of civility is defined as disrespectful or rude behavior.
4. Bullying is a broad term used to describe many behaviors. It is not specific to this situation.

Question 15

A nurse writes some scathing remarks about another nurse's professionalism on a social media site. A complaint of bullying is lodged with the nurse manager. Which statement by the manager is appropriate?
A) "I have no control over what the nurses do on their time away from work."
B) "This does not meet the standards for bullying because it was not a face-to-face encounter."
C) "You two are acting like a couple of high school kids."
D) "I will follow up on this complaint and take action as needed."

Accepted Answer

The appropriate response is for the manager to take the complaint seriously, investigate the situation, and take appropriate action. The behavior described is unprofessional and potentially harmful to the other nurse's reputation, so it needs to be addressed promptly. Option A is dismissive and unhelpful. Option B is incorrect because bullying can occur through online communication as well. Option C is unprofessional and not helpful in resolving the situation.

Question 16

An error made in client care last week has just been discovered. A nurse who cared for the client during that period is asked about the error and states, "That probably happened when the nurse covering for me at noon or for my breaks was in charge." How should the manager interpret this statement?
A) This is a plausible explanation of who was in charge at the time of the error.
B) The coverage nurse is likely incompetent.
C) This nurse was not in charge when the error was made.
D) This nurse is scapegoating the coverage nurse.

Accepted Answer

1. A statement this broad is likely not a clear explanation.
2. There is no indication that the coverage nurse is incompetent.
3. There is no evidence that this nurse was not in charge when the error was made.
4. By raising the possibility (and being very sure) that the other nurse was in charge, the nurse has created a scapegoat. This is a form of lateral violence.

Question 17

A nurse comes to the unit manager to report a coworker's behavioral changes. The nurse has noticed that the coworker's handwriting has become shaky and illegible, that the coworker has mood swings, and that the coworker has had increased tardiness. Which should be the manager's first action?
A) Meet with the coworker in private and discuss the behaviors.
B) Meet with other staff to determine if the coworker has issues at home.
C) Meet with human resources (HR) to determine the best method to terminate the employee.
D) Collect additional information regarding behaviors, absenteeism, and/or tardiness.

Accepted Answer

The manager's first action should be to collect additional information about the coworker's behaviors, absenteeism, and/or tardiness to better understand the situation. This information can help determine the appropriate next steps and whether any intervention or support is needed for the coworker. Meeting with the coworker in private should also be considered, but additional information should be collected first. Meeting with other staff to determine if the coworker has issues at home may not be appropriate, as it is not the manager's place to inquire about personal issues unless the coworker chooses to share them. Meeting with HR to determine the best method of termination is premature at this point and should only be considered if all other options have been exhausted.

Question 18

A group of nursing students have just arrived on the unit. Which actions by staff would be considered uncivil to these students?
A) The unit clerk groans when the instructor enters the nursing station with the students.
B) A nurse quietly says, "Please do not assign a student to me today. I have two very sick clients who are going to require my full attention."
C) A nurse whispers, "Not students again today."
D) A nursing assistant asks the students how long they have been in school.
E) A transport worker says, "Just great, more students to get in the way today."

Accepted Answer

These actions are uncivil because they are disrespectful and unprofessional. The unit clerk's groan is a sign of annoyance, the nurse's whisper is a negative comment, and the transport worker's statement is rude.

Question 19

A manager has documentation to suspect substance abuse by a nurse. The manager meets with the human resources (HR) director to determine which course of action should be taken to abide by the organization's policies. Which statement by the HR director is appropriate?
A) "We should meet with the nurse and offer access to the employee assistance program."
B) "We should confront the employee and discuss involuntary or voluntary termination."
C) "You need to meet with this nurse and confront these behaviors."
D) "We need to set up a counseling session with a psychologist and this nurse."

Accepted Answer

Meeting with the nurse and offering access to the employee assistance program is the most appropriate choice as it shows concern for the employee's well-being and offers support for potential substance abuse issues. This approach aligns with the organization's policies around employee assistance programs and can lead to positive outcomes for both the nurse and the organization. Confrontation and termination should only be considered as a last resort after supportive measures have been taken. Setting up a counseling session with a psychologist can also be a helpful step, but should be done in conjunction with offering access to the employee assistance program.

Question 20

The nurse manager becomes aware of frequent incorrect narcotics counts on the night shift. This is verified by the pharmacy. What should be the first action taken by the manager?
A) Call a meeting of all night shift employees.
B) Review the staffing pattern and absentee list for the night shift.
C) Ask employees for their perceptions on missing narcotics.
D) Request that security search employee lockers and personal items.

Accepted Answer

The first action should be to review the staffing pattern and absentee list for the night shift to identify any possible causes for the incorrect counts. This can help the manager identify if there are any patterns or trends related to certain employees or shifts that may be contributing to the issue. Calling a meeting or asking for employee perceptions should be done after these initial steps to address the issue. Requesting that security search employee lockers and personal items should only be done as a last resort and with proper legal and ethical considerations.

Quiz 21: Dealing With Staff Problems

The nurse executive works hard to create a civil workplace that does not tolerate harassing behaviors. How would this nurse best explain the reason for this emphasis on civility?

A nurse makes a medication error and notifies the client's physician. The physician berates the nurse over the phone and states, "You are an idiot." How should the manager deal with this situation?

A hospital administrator has attended a conference on bullying and wishes to address the most likely bullies in the organization. Whom would the administrator invite to the first meeting about bullying behaviors?

A hospital administrator is investigating why the turnover rate is so high and why it is difficult to attract new nursing employees. Which situation is most likely to have resulted in this problem?

The manager has determined that a nurse is marginal, but elects to ignore the situation for now, hoping the nurse's work will improve. What risks has the manager taken by choosing this strategy?

What characteristics would cause the manager to classify an employee as marginal?

A nurse manager does not like conflict and would like to allow instances of bullying to "go away on their own." What rationale by the manager's supervisor is the most important?

Two staff members have a long-standing dislike of one another. Generally they hide their feelings, but occasionally they engage in name-calling and derogatory remarks. Today their dislike erupted into a shoving match in the break room. How should the manager handle this situation?

A nurse manager is struggling with two marginal nurses and goes to the supervisor for advice. How should the supervisor advise the manager?

A nurse says, "I don't see what all the fuss is about bullying. Every new nurse has to go through it. It's just a part of the history of nursing." How should the manager respond?

Which assignment would be in the best interest of a nurse reentering practice following treatment for abuse of mood-altering drugs?

A night shift charge nurse frequently points out nurses' faults in front of coworkers. The manager of the unit has submitted a written warning to the charge nurse. What term should the manager use to label this behavior?

A nurse writes some scathing remarks about another nurse's professionalism on a social media site. A complaint of bullying is lodged with the nurse manager. Which statement by the manager is appropriate?

An error made in client care last week has just been discovered. A nurse who cared for the client during that period is asked about the error and states, "That probably happened when the nurse covering for me at noon or for my breaks was in charge." How should the manager interpret this statement?

A nurse comes to the unit manager to report a coworker's behavioral changes. The nurse has noticed that the coworker's handwriting has become shaky and illegible, that the coworker has mood swings, and that the coworker has had increased tardiness. Which should be the manager's first action?

A group of nursing students have just arrived on the unit. Which actions by staff would be considered uncivil to these students?

A manager has documentation to suspect substance abuse by a nurse. The manager meets with the human resources (HR) director to determine which course of action should be taken to abide by the organization's policies. Which statement by the HR director is appropriate?

The nurse manager becomes aware of frequent incorrect narcotics counts on the night shift. This is verified by the pharmacy. What should be the first action taken by the manager?